ICD-10-CM is coming Be Ready! - ncsos.memberclicks.net presentation... · ICD-10-CM is coming Be...
Transcript of ICD-10-CM is coming Be Ready! - ncsos.memberclicks.net presentation... · ICD-10-CM is coming Be...
ICD-10-CM is comingBe Ready!
REBECCA H WARTMAN OD
HARVEY RICHMAN OD FAAO FCOVD
AUGUST 2015
NORTH CAROLINA STATE OPTOMETRIC SOCIETY
1.All information was current at time it was prepared
2.Drawn from national policies, with links included in the presentation for
your use
3.Prepared as a tool to assist doctors and staff and is not intended to grant rights or impose obligations
4.Prepared and presented carefully to ensure the information is accurate, current and relevant
Disclaimers for Presentation
Disclaimers for Presentation
5. The ultimate responsibility for the correct submission of claims and compliance with provider contracts lies with the provider of services
6. AOA, AOA-TPC, NCSOS, its presenters, agents, and staff make no representation, warranty, or guarantee that this presentation and/or its contents are error-free and will bear no responsibility or liability for the results or consequences of the information contained herein
7. Conflicts: Neither Harvey or Rebecca have financial support but RHW is a paid consultant to Eye Care Center OD PA
What we will cover today
Overview of ICD-10-CM: Why and How
How to prepare
ICD-CM-Coding System Overview◦ Alphabetical Indexes◦ Tabular Index
ICD-10-CM Code Details and Nomenclature
ICD-10-CM Coding Examples
Summary and Resources
Questions
ICD-10-CM Conversion
September 30, 2015◦All encounter on or before this date
◦ ICD-9-CM codes
◦Even for Refiling, appeals etc
October 1, 2015◦All encounters on or after this date
◦ ICD-10-CM codes
July 6,2015: Breaking NewsAMA Announces Agreement with CMSFor first year of ICD-10-CM, CMS and Recovery Audit Contractors will abide by the following:
1. Will not deny claims solely based on diagnosis specificity if code used is from appropriate ICD-10 code family → will not deny for unintentional errors
2. Will not subject physicians to penalties for PQRS, value-based payment modifier or meaningful use if code used is from appropriate ICD-10 code family
3. No penalties will not be applied if CMS experiences difficulties calculating quality scores for these programs due ICD-10 implementation
4. Will authorize advance payments to physicians if contractors are unable to process claims due to ICD-10 problems
5. Will establish communication center to monitor and resolve issues quickly, including an “ICD-10 ombudsman” to triaging physician issues
http://www.ama-assn.org/ama/ama-wire/post/cms-icd-10-transition-less-disruptive-physicians
Diagnosis codes without decimal points
Example Acute atopic conjunctivitis
372.14 37214 ICD-9-CM
H10.13 H1013 ICD-10-CM
Note: Can ONLY link 4 diagnoses codes to any examination or procedure line!!
But can list up to 12 diagnoses per claim!
CMS 1500 02/12 Changes
Overview of ICD-10-CM
1st
• ICD-10-CM/PCS• (International Classification of Diseases, 10th Edition, Clinical
Modification /Procedure Coding System)
2nd• ICD-10-CM for diagnosis coding • ICD-10-PCS for inpatient procedure coding (Hospitals only)
3rd• ICD-10-CM replaces ICD-9-CM• Does not change use of CPT® in any way
Why change ICD-9-CM ICD-10-CM?
ICD-9-CM is 30 years old
•Produces limited data about medical conditions •Uses outdated terms•Is inconsistent with current medical practice•Structure limits number of new codes•Many ICD-9 categories are full
ICD-10-CM everywhere since 1994 (except the US and Italy)
Published by World Health Organization (WHO)
US Version maintained by Centers for Disease Control (CDC)
ICD-10-CM ImprovementsHarmonizes with other classifications
Removes relationships with procedure codes
Revises diabetes codes - consistent with ADA
Information on diseases and conditions and causes grouped as follows:
• Communicable diseases
• General diseases that affect the whole body
• Local diseases arranged by site
• Developmental diseases
• Injuries
• External causes
Revised Timeline for Change Preparation
Planning Jan-Feb 2014
• Identify resources – Create project team – Assess effects
• Create project plan - Secure budget
Communications Jan 2014- June 2015
• Inform staff – Contact vendors/ payers Jan-Feb 2014
• Monitor vendor prep March-Dec 2014
• Monitor payer prep March 2014– June 2015
Testing April 2014-Sept 2015
• Level 1: internal April- Dec 2014
• Level 2: external Oct 2014 – Sept 2015
Comprehensive Training April 2014+
• Documentation April 2014 and beyond
• Coding April 2014 and beyond
Review your use of ICD-9-CM
Develop/Review Your Current ICD-9-CM Uses List
• Authorizations/pre-certifications
• Medical records
• Superbills/Encounter forms
• Practice management and billing systems
• Coding manuals
• Etc
Improve Clinical Documentation
!• Review current documentation habits
!!• Is documentation specific and detailed
ICD-10-CM will not affect the way you provide care but gives more specific diagnosis choices
Specifics of DocumentationSI
TE Cornea
Conjunctiva
Retina
EtcLA
TER
IALI
TY Right eye
Left Eye
LOC
ATI
ON Central
Peripheral
Macular
Etc
Specifics of DocumentationIF
INJU
RY External cause
HOW?
Place of occurrence WHERE?
home, work, in car, etc
Activity code
WHAT?
sports, using tool, etc
External cause status
work, military, home etc
IF IN
FEC
TIO
N Organism ?
Related to?
• Surgery , injury etc
Sometimes coded BUT NOT ALWAYS
Must read specifics for each condition
IF S
YSTE
MIC Type of disease
Body system(s) affected
Complication or manifestation
Type 2 DM→long-term insulin use
US Version of ICD-10-CM NOT WHO Version
ICD-10-CM owned by World Health Organization
BUT for United States –
ICD-10-CM code set - maintained by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC) for use in the United States
Thus some different rules will apply for US vs World Health Organization versions of code set
www.cdc.gov/nchs/icd/icd10cm.htm
ICD-9-CM vs ICD-10-CMICD-9-CM ICD-10-CM
ICD-9-CM= 13,000 codes ICD-10-CM =68,000 +
3-5 characters 3 -7 characters
Character 1= # or alpha (V,E) Character 1= alpha (except U)
Character 2-5= # Character 2 =#
Characters 3-7=alpha or #
Decimal after 3 characters
ICD-10:Dummy placeholder “x” used when need 7th character
Alpha characters not case-sensitive
ICD-10-CM
Determine conditions for coding from medical documentation following ICD rules
Use Alphabetical Index to locate condition and allocate code
Use Tabular Listing to review all coding instructions related to code (e.g. inclusion, exclusion)
Use Instruction Manual for any rules regarding selection for reporting mortality/morbidity
Overview of ICD-10-CM Alphabetical Index
-...
Alphabetical list of terms and corresponding code1. Index of Diseases and Injury2. Index of External Causes of Injury3. Table of Neoplasms4. Table of Drugs and Chemicals
This is where you begin! Can make errors if you do not start here!Alphabetical list of codes from the Tabular List
Overview of ICD-10-CM Alphabetical Index
Syndromes under “syndrome” listing◦ Dry eye syndrome
◦ Not under corneal◦ Not under lacrimal◦ Not under ocular◦ UNDER SYNDROME
Dysfunctions under “dysfunctions” listing
Degenerations under “degeneration” listing◦ Macular degeneration
◦ Not under retinal ◦ Not under macula◦ UNDER DEGENERATION
Helpful Hint
ICD-10-CM Terminology and ConventionsAlphabetic Index Example
Macula- cornea, corneal —see Opacity, cornea
- degeneration (atrophic) (exudative) (senile) —see also Degeneration, macula
- - hereditary —see Dystrophy, retina
Degeneration, degenerative- macula, macular (acquired) (age-related) (senile) H35.30
- - angioid streaks H35.33
- - atrophic age-related H35.31
- - congenital or hereditary —see Dystrophy, retina
- - cystoid H35.35-
- - drusen H35.36-
- - exudative H35.32
- - hole H35.34-
- - nonexudative H35.31
- - puckering H35.37-
- - toxic H35.38-
ICD-10-CM Terminology and ConventionsTabular ListTabular list →chapters ►body system/condition
Divided into categories, subcategories and codes Can ONLY report codes
• If has no further subdivision is equivalent to codeCategories-3 characters
• Each level of subdivision after a category is a subcategory
• If no further subdivision is equivalent to a code
Subcategories - 4 or 5 characters
• Final level of subdivision
• If 7th character is required invalid without 7th character
• If placeholder needed-X used for code to be valid code
Codes- 3, 4, 5, 6 or 7 characters
ICD-10-CM Terminology and ConventionsTabular List
H35 Other Retinal Disorders
H35.3 Degeneration of macula and posterior poleH35.30 Unspecified macular degeneration
Age-related macular degenerationH35.31 Nonexudative age-related macular degeneration
Atrophic age-related macular degenerationH35.32 Exudative age-related macular degenerationH35.33 Angioid streaks of maculaH35.34 Macular cyst, hole, or pseudohole
H35.341 …… right eyeH35.342 …… left eyeH35.343 …… bilateralH35.349 …… unspecified eye
Category
Subcategory that is Code
Subcategory NOT a code
These are final codes
ICD-10-CM Terminology and Conventions7th Characters
If code requires 7th character but is not 6 characters long THEN must use placeholder X to fill in empty characters
The 7th character must be 7th character in data field
When 7th character is required →used for all codes within category or as noted in Tabular List instructions
Certain ICD-10-CM categories need 7th character
ICD-10-CM Terminology and ConventionsPunctuation
[ ] Brackets
–Alphabetic Index: identify manifestation codes
–Tabular List: enclose synonyms, alternative wording or explanatory phrases
( ) Parentheses
–Alphabetic Index and Tabular List :
enclose supplementary words that may or may not be present in statement of disease or procedure without affecting code number assignment
: Colons
–Tabular List: after incomplete term which needs one or more of modifiers following colon to make it assignable to a category
Important!!
Alphabetic Index: Disorders of the Retina H33Retinochoroiditis —see also Inflammation, chorioretinal
- disseminated —see Inflammation, chorioretinal, disseminated
- - syphilitic A52.71
- focal —see Inflammation, chorioretinal
- juxtapapillaris —see Inflammation, chorioretinal, focal, juxtapapillary …
Retinopathy (background) H35.00
- arteriosclerotic I70.8 [H35.0-]
- atherosclerotic I70.8 [H35.0-]
- central serous —see Chorioretinopathy, central serous
- Coats H35.02-
- diabetic —see Diabetes, retinopathy
- exudative H35.02-
- hypertensive H35.03- …
Retinoschisis H33.10-
- congenital Q14.1
- specified type NEC H33.19-
Carefully note sections and codes in [ ]
For Alphabetic Index Both conditions are listed together Etiology first then manifestation codes [ ]Code in brackets always coded second BUT sometimes NOT noted in Alphabetical Index!!
ICD-10-CM Terminology and ConventionsIncludes Notes
Includes Notes: immediately under three character code title
further define or give examples of category content
Inclusion terms are list of terms included under some codes
Defines when code is to be used
May be synonyms of the code title
For “other specified” codes is list of various conditions assigned to code
BUT not necessarily exhaustive
Additional terms found only in the Alphabetic Index may also be assigned to a code
ICD-10-CM Terminology and ConventionsExcludes Notes
Excludes1
Pure excludes note- meaning “NOT CODED HERE!”
Excluded code should never be used at same time as code above Excludes1 note
Used when two conditions cannot occur together
(Example: congenital versus acquired form of same condition
Excludes2
Means “Not included here”
Excluded condition is not part of condition represented by code,
BUT patient may have both conditions at the same time
Excludes2 code acceptable to use when both the code and excluded code occur together
ICD-10-CM Terminology and ConventionsExamples
H53 Visual disturbances
H53.0 Amblyopia ex anopsia
Excludes1: amblyopia due to vitamin A deficiency (E50.5)
H53.00 Unspecified amblyopia
H11.1 Conjunctival degenerations and deposits
Excludes2: pseudopterygium (H11.81)
H11.10 Unspecified conjunctival degenerations
H11.11Conjunctival deposits
Excludes 1 note
Excludes 2 note
ICD-10-CM Sequencing Order Tabular Notes
“In diseases classified elsewhere” codes:◦ Never permitted to be used as first-listed diagnosis code
◦ Must be used with underlying condition code
◦ Must be listed following the underlying condition
But some manifestation codes do not have “in diseases classified elsewhere” in title◦ “use additional code” note for the etiology code
◦ “code first” note at the manifestation code
◦ Rules for sequencing apply→
etiology code then manifestation code
ICD-10-CM Terminology and ConventionsOther Nomenclature
“Code also” note
Instructs that two codes may be required to fully describe condition, but this note does not provide sequencing direction
Default codes
Listed next to a main term in Alphabetic Index
The default code represents condition most commonly associated with main term or is the unspecified code for the condition
If condition is documented in medical record (for example, appendicitis) without any additional information, such as acute or chronic, the default code should be assigned
Your success rate for properly billing ICD-10-CM will depend on your properly selecting the impressions and proper laterality in your electronic medical record program
Typically your ICD-10-CM code choices will be a one-to-one correlation with your choices for ICD-9-CM witin your electronic medical record program.
ICD-10-CM and Electronic Medical Records
ICD-10-CM and Electronic Medical Records
If the code you need is due to drug or chemical interactions, any underlying condition or certain atypical diabetes, such as secondary or gestational, then you will need to ensure the code choice is proper and correct. And, again, remember to choose the proper laterality to obtain the most specific codes.
You need to be aware of the correct includes and Excludes1 and Excludes2 Notes to further ensure the correct code(s) have be chosed within your electronic medical records.
H00-H05→Disorders of eyelid, lacrimal system, orbit
H10-H11→Disorders of conjunctiva
H15-H22→Disorders of sclera, cornea, iris, ciliary body
H25-H28→Disorders of lens
H30-H36→Disorders of choroid and retina
H40-H42→Glaucoma
H43-H44→Disorders of vitreous body and globe
H46-H47→Disorders of optic nerve & visual pathways
H49-H52→Disorders of ocular muscles, binocular movement, accommodation and refraction
H53-H54→Visual disturbances and blindness
H55-H57→Other disorders of eye and adnexa
H 59 →Intraoperative and postprocedural complications and disorders
Tabular Index Chapter VII Categories
Chapter VII Diseases of the eye and adnexa(H00-H59) Notes and Exclusions
Note: Use an external cause code following the code for the eye condition, if applicable, to identify the cause of the eye condition
Excludes2:
Certain conditions originating in the perinatal period (P04-P96)
Certain infectious and parasitic diseases (A00-B99)
Complications of pregnancy, childbirth and the puerperium (O00-O9A)
Congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
Diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)
Endocrine, nutritional and metabolic diseases (E00-E88)
Injury (trauma) of eye and orbit (S05.-)
Injury, poisoning and certain other consequences of external causes (S00-T88)
Neoplasms (C00-D49)
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)
Refractive DiagnosesAlphabetic Index
Astigmatism (compound) (congenital) H52.20-
- irregular H52.21-
-regular H52.22-
Hypermetropia (congenital) H52.0-
Myopia (axial) (congenital) H52.1-
- degenerative (malignant) H44.2-
- malignant H44.2-
- pernicious H44.2-
-progressive high (degenerative) H44.2-
Presbyopia H52.4
Alphabetical Index:External Hordeolum (373.11)
•Eye, eyeball, eyelid —see condition
•Sty, stye (external) (internal) (meibomian) (zeisian) —see Hordeolum
•Hordeolum (eyelid) (externum) (recurrent) H00.019
-internum H00.029
--left H00.026
---lower H00.025
---upper H00.024
--right H00.023
---lower H00.022
---right H00.021
- left H00.016
- - lower H00.015
- - upper H00.014 . . .
Tabular List:Hordeolum, External H00.01 (373.11)
Code to specific eye and eyelid when possible and appropriate per Tabular Listing
Alphabetical Index: Blepharitis 373.00
Blepharitis (angularis) (ciliaris) (eyelid) (marginal) (nonulcerative) H01.009
- herpes zoster B02.39
- left H01.006
- - lower H01.005
- - upper H01.004
- right H01.003
- - lower H01.002
- - upper H01.001
- squamous H01.029
- - left H01.026
- - - lower H01.025
- - - upper H01.024
- - right H01.023
- - - lower H01.022
- - - upper H01.021
- ulcerative H01.019
- - left H01.016
- - - lower H01.015
- - - upper H01.014
- - right H01.013
- - - lower H01.012
- - - upper H01.011
Note: H zoster blepharitis is under different code set- B
Tabular List : Blepharitis H01.0 (373.00)
REMEMBER: Blepharitis has two other categories:Ulcerative H01.01 and Squamous H01.02
Excludes1 Note!
Other Things to Notice in Eyelid Section
H02.0 Entropian and trichiasis of eyelidH02.05 Trichiasis without entropian
H02.051Trichiasis without entropian right upper eyelid
H02.052Trichiasis without entropian right lower eyelid
H02.053Trichiasis without entropian right eye, unspecified eyelid
H02.054Trichiasis without entropian left upper eyelid
H02.055Trichiasis without entropian left lower eyelid
H02.056Trichiasis without entropian left eye, unspecified eyelid
H02.059Trichiasis without entropian unspecified eye, unspecified eyelid
Entropion is spelled entropian in this particular entry of CDC official version
Trichiasis is separate section for trichiasis without entropion as opposed to entropion –broken into unspecified, cicatricial, mechanical, senile and spastic
Disorders of conjunctiva (H10 – H11)H10.0 Mucopurulent conjunctivits
H10.1 Acute Atopic conjunctivitis
H10.2 Other acute conjunctivitis
H10.3 Unspecified acute conjunctivitis
H10.4 Chronic conjunctivitis
H10.5 Blepharoconjunctivitis
H10.8 Other conjunctivitis
H11.0 Pterygium of eye
H11.1 Conjunctival degenerations and deposits
H11.2 Conjunctival scars
H11.3 Conjunctival hemorrhage
H11.4 other conjunctival vascular disorders and cysts
H11.8 Other specified disorders of conjunctiva
H11.9 Unspecified disorder of conjunctiva
Each of these subcategories are further divided into right eye, left eye, bilateral or unspecified eye codes
Disorders of Conjunctiva Exclusions-H10H10 Conjunctivitis
Excludes1: keratoconjunctivitis (H16.2-)H10.21 Acute toxic conjunctivitis
Acute chemical conjunctivitis
Code first (T51-T65) to identify chemical and intent
Excludes1:burn and corrosion of eye and adnexa (T26.-)
H10.3 Unspecified acute conjunctivitis
Excludes1: ophthalmia neonatorum NOS (P39.1)
H10.44 Vernal conjunctivitis
Excludes1: vernal keratoconjunctivitis with limbar and corneal involvement (H16.26-)
H10.81 Pingueculitis
Excludes1: pinguecula (H11.15-)
Code First Note
Important to note all Excludes1 Notes
Disorders of Conjunctiva Exclusions-H11H11 Other disorders of conjunctiva
Excludes1: keratoconjunctivitis (H16.2-)
H 11.0 Pterygium of eye
Excludes1: pseudopterygium (H11.81-)
H11.1 Conjunctival degenerations and deposits
Excludes2: pseudopterygium (H11.81)
H11.14 Conjunctival xerosis, unspecifiedExcludes1: xerosis of conjunctiva due to vitamin A deficiency (E50.0, E50.1)
H11.15 Pinguecula
Excludes1: pingueculitis (H10.81-)
Excludes2 Note
Alphabetical Index: Conjunctivitis (372.01, 372. 05, 372.13, 372.14)Conjunctivitis (staphylococcal) (streptococcal) NOS H10.9
- Acanthamoeba B60.12- acute H10.3-- - atopic H10.1-- - mucopurulent H10.02-- - - follicular H10.01-- - chemical (see also Corrosion, cornea) H10.21-- - pseudomembranous H10.22-- - serous except viral H10.23-- - - viral —see Conjunctivitis, viral- - toxic H10.21-- adenoviral (acute) (follicular) B30.1- allergic (acute) —see Conjunctivitis, acute, atopic-- chronic H10.45 etc MANY MORE CODES UNDER CONJUNCTIVITIS
Note the “See” so must go to this entry
Note “See also” so can follow but optional
Tabular ListConjunctivitis, acute mucopurulent H10.02-Conjunctivitis H10
Excludes1 keratoconjunctivitis (H16.2-)
H10.0 Mucopurlent conjunctivitis
H10.01 Acute follicular conjunctivits
H10.011 Acute folloicular conjunctivitis, right eye
H10.012 Acute folloicular conjunctivitis left eye
H10.013 Acute folloicular conjunctivitis bilateral
H10.019 Acute folloicular conjunctivitis unspecified eye
H10.02 Other mucopurulent conjunctivitis
H10.021 Other mucopurulent conjunctivitis right eye
H10.022 Other mucopurulent conjunctivitis left eye
H10.023 Other mucopurulent conjunctivitis bilateral
H10.029 Other mucopurulent conjunctivitis unspecified eye
Must specify eye when coding conjunctivitisMany other codes for conjunctivitis exist
“Run of the mill” bacterial conjunctitivis is typically under
mucopurulent conjunctivitisAlso simple, follicular, etc
Alphabetical Index Conjunctivitis, viral, adenovirus (372.01)
Note:Code not in H10 section But in B section
USE ALPHABETICAL INDEX TO LOOK UP CODES
Tabular ListConjunctivitis, viral, adenovirus B30.1
Note Excludes1 under heading Note specific code definition
NOT PER EYE HERE
Alphabetic Index: Dry Eye Syndrome (375.15)
Dry, dryness —see also condition
- larynx J38.7
- mouth R68.2
- - due to dehydration E86.0
- nose J34.89
- socket (teeth) M27.3
-throat J39.2
Keratoconjunctivitis H16.20-…
sicca (Sjogren's) M35.0-
-- not Sjogren's H16.22-
Syndrome —see also Disease
- dry eye H04.12-
NO DRY EYE LISTED
NO DRY EYE LISTED
FINALLY find under “syndrome”
Tabular List: Dry Eye Syndrome (375.15;370.33)
H04.12 Dry eye syndrome
Tear film insufficiency, NOS H04.121 Dry eye syndrome of right lacrimal gland
H04.122 Dry eye syndrome of left lacrimal gland
H04.123 Dry eye syndrome of bilateral lacrimal glands
H04.129 Dry eye syndrome of unspecified lacrimal gland
H16.22 Keratoconjunctivitis sicca, not specified as Sjögren's
Excludes1: Sjögren's syndrome (M35.01)
H16.221 Keratoconjunctivitis sicca, not specified as Sjögren's, right eye
H16.222 Keratoconjunctivitis sicca, not specified as Sjögren's, left eye
H16.223 Keratoconjunctivitis sicca, not specified as Sjögren's, bilateral
H16.229 Keratoconjunctivitis sicca, not specified as Sjögren's, unspecified eye
Note: Dry eye is under lacrimal Keratitis sicca is under keratitis
Cataract, Nuclear Sclerotic (366.16)Alphabetic Index
Note descriptions in ( ) not for senile
“Nuclear” directs to Cataract, senile, nuclear
Finally directed to proper subcatergory
“Age related” links to Cataract, senile
Tabular ListCataract, nuclear sclerotic,senile H25.1
Make sure you note heading excludes notes!
Note 5th and 6th digits – Sometimes 9 = unspecified, sometimes 0 = unspecified
Alphabetical Index: Pseudophakia
Pseudoparalysis
- arm or leg R29.818
- atonic, congenital P94.2
Pseudopelade L66.0
Pseudophakia Z96.1
Pseudopolyarthritis, rhizomelic M35.3
Pseudopolycythemia D75.1
Pseudopseudohypoparathyroidism E20.1
Tabular Listing: Pseudophakia
Found in Chapter 21: Factors Influencing Health Status and Contact
This one is EASY!
Could be difficult to find proper code if do not use Alphabetical Index first!!
Disorders of choroid and retina (H30-H36)
H30 Chorioretinal inflammation
H31 Other disorders of choroid
H32 Chorioretinal disorders in diseases classified elsewhere
H33 Retinal detachments and breaks
H34 Retinal vascular occlusions
H35 Other retinal disorders
H 36 Retinal disorders in diseases classified elsewhere
Disorders of choroid and retina H32Entire Section
Code First: Must code the other disease before code the chorioretinal disorderExcludes1 code means you cannot code these diagnoses together
Chorioretinal Scar of Posterior Pole ExampleAlphabetic Index
- chorioretinal H31.00-
- - posterior pole macula H31.01-
- - postsurgical H59.81-
- - solar retinopathy H31.02-
- - specified type NEC H31.09-
- choroid —see Scar, chorioretinal
Scar, scarring (see also Cicatrix) L90.5
Go to H31.01- or H 31.02- section of tabular listingDepends on cause of the scar
Chorioretinal Scar, Posterior Pole OD ExampleTabular Index
Appropriate code is H31.011 if macular
But could be H31.021 if known solar retinopathy scar
Toxoplasmosis Scarring of Choroid OSAlphabetic IndexChorioretinitis —see also Inflammation, chorioretinal
- disseminated —see also Inflammation, chorioretinal, disseminated…- focal —see also Inflammation, chorioretinal, focal- histoplasmic B39.9 [H32]- in (due to)- - histoplasmosis B39.9 [H32]- - syphilis (secondary) A51.43- - - late A52.71- - toxoplasmosis (acquired) B58.01- - - congenital (active) P37.1 [H32]…
Toxoplasma, toxoplasmosis (acquired) B58.9
- with- - hepatitis B58.1- - meningoencephalitis B58.2- - ocular involvement B58.00- - other organ involvement B58.89- - pneumonia, pneumonitis B58.3- congenital (acute) (subacute) (chronic) P37.1
The section to review for toxoplasmosis ocular involvement-both references
Toxoplasmosis Scarring of Choroid OSTabular Lookup
Toxoplasmosis scar of choroid code found here
Not under H 30 or H31 sectionsREMEMBER Excludes1 note reviewed
Code would be B58.01NOT PER EYE
Choroidal Nevus, Both eyes ExampleAlphabetical Index
Nevus D22.9
- achromic —see Neoplasm, skin, benign
- amelanotic —see Neoplasm, skin, benign
. . .
- choroid D31.3-
- comedonicus Q82.5
- conjunctiva D31.0-
Note: Choroidal & conjunctival nevus are NOT under H
Choroidal Nevus, Both eyes ExampleTabular Listing
Note this code is per eye while some are NOT PER EYENEED TO USE BOTH D31.31 AND D31.32
Alphabetic Index: Disorders of the Retina H33Retinochoroiditis —see also Inflammation, chorioretinal
- disseminated —see Inflammation, chorioretinal, disseminated
- - syphilitic A52.71
- focal —see Inflammation, chorioretinal
- juxtapapillaris —see Inflammation, chorioretinal, focal, juxtapapillary …
Retinopathy (background) H35.00
- arteriosclerotic I70.8 [H35.0-]
- atherosclerotic I70.8 [H35.0-]
- central serous —see Chorioretinopathy, central serous
- Coats H35.02-
- diabetic —see Diabetes, retinopathy
- exudative H35.02-
- hypertensive H35.03- …
Retinoschisis H33.10-
- congenital Q14.1
- specified type NEC H33.19-
Carefully note sections and codes in [ ]
For Alphabetic Index Brackets NOT always used in alphabetic index…Sometimes 2nd code indicated in Tabular Listing…
ICD-10-CM: HTN RetinopathySequencing Order Tabular Notes
H35 Other retinal disorders
Excludes2: diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359,E13.311-E13.359)
H35.0 Background retinopathy and retinal vascular changes
Code Also any associated hypertension (I10.-)
H35.00 Unspecified background retinopathy...
H35.03 Hypertensive retinopathy
H35.031 Hypertensive retinopathy, right eye
H35.032 Hypertensive retinopathy, left eye
H35.033 Hypertensive retinopathy, bilateral
H35.039 Hypertensive retinopathy, unspecified eye
Code Also tells you to code HTN first but not in Alphabetic Index
ICD-10-CM: HTN RetinopathySequencing Order Tabular Notes
I10 Essential (primary) hypertension
Includes: high blood pressure
hypertension (arterial) (benign) (essential) (malignant)(primary) (systemic)
Excludes1: hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11, O13-O16)
Excludes2: essential (primary) hypertension involving vessels of brain (I60-I69)
essential (primary) hypertension involving vessels of eye (H35.0-) Excludes2 note
I 10 Essential HypertensionH35.033 Hypertensive Retinopathy, bilateral
Must code both and must be in this order per alphabetical index and tabular list instructions
Retinal Detachment Giant Tear-Right Eye Alphabetical Index
Detachment
- retina (without retinal break) (serous) H33.2-
- - with retinal:
- - - break H33.00-
- - - - giant H33.03-
This would be starting point
REMEMBER: Very few listings under retina so must look under condition- detachment
Age Related Macular DegenerationAlphabetic Index
Macula- cornea, corneal —see Opacity, cornea- degeneration (atrophic) (exudative) (senile) —see also Degeneration,
macula- - hereditary —see Dystrophy, retina
Degeneration, degenerative- macula, macular (acquired) (age-related) (senile) H35.30- - angioid streaks H35.33- - atrophic age-related H35.31- - congenital or hereditary —see Dystrophy, retina- - cystoid H35.35-- - drusen H35.36-- - exudative H35.32- - hole H35.34-- - nonexudative H35.31- - puckering H35.37-- - toxic H35.38-
Options H35.30 or H35.32 or H35.31 Depending on type of ARMD
ARMD-Moderate Dry Right, Mild LeftTabular Look Up
When you THOUGHT you had figured it out!NOT eye specific and NOT degree specific!
If only drusen you would code H35.36-
Coding Guidelines for Glaucoma
1. Assigning Glaucoma Codes
Assign as many codes from category H40, Glaucoma, necessary to identify
a) type of glaucoma
b) affected eye
c) glaucoma stage
2. Bilateral glaucoma with same type and stage
If code for bilateral glaucoma, report only bilateral code, with seventh character for stage
If no code for bilateral glaucoma, report only one code for type of glaucoma with seventh character for stage
Coding Guidelines for Glaucoma3. Bilateral glaucoma stage with different types or stages
a) Each eye different type or stage, and the classification distinguishes laterality= one code for each eye
a) Each eye different type, but classification does not distinguish laterality = one code for each type of glaucoma with seventh character for stage (subcategories H40.10, H40.11 and H40.20)
b) Each eye has same type, but different stage, and classification does not distinguish laterality =
THEN
One code for type for each eye + seventh character for stage for each eye
Coding Guidelines for Glaucoma
4. Indeterminate stage glaucoma
Assignment seventh character “4” for “indeterminate stage” based on clinical documentation – use when stage cannot be clinically determined
This seventh character “0”, unspecified, which should be assigned when no documentation regarding stage of glaucoma
http://www.americanglaucomasociety.net/professionals/glaucoma_staging_codes_teaching_module/
If you are not familiar with Glaucoma Staging- see link below
Coding Guidelines for Glaucoma
Each glaucoma code that requires 7th character is clearly indicated in Tabular Listing
Primary Open Angle Glaucoma OUMild OD, severe OS
Alphabetical Index
Glaucoma:
- open angle H40.10-
- - primary H40.11-
- - - capsular (with pseudoexfoliation of lens) H40.14-
- - - low-tension H40.12-
- - - pigmentary H40.13-
-- residual stage H40.15-
Must go to section H40.11- in Tabular Listing
Primary Open Angle Glaucoma OUMild OD, severe OS
Tabular Listing H40.11-This code is NOT per eye!!
Final Codes-must have BOTH codes AND X placeholderH40.11X1 and H40.11X3
Mixed Glaucoma Example
Alphabetical Index:
Glaucoma:
-low tension —see Glaucoma, open angle, primary, low-tension
- - primary H40.11-
- - - capsular (with pseudoexfoliation of lens) H40.14-
- - - low-tension H40.12-
- - - pigmentary H40.13-
-- residual stage H40.15-
Must go to section H40.11 and H40.12- in Tabular Listing
Low Tension Glaucoma, left eye, moderate stagePrimary Open Angle Glaucoma, right eye, severe stage
Mixed Glaucoma Example
Tabular Listing 40.12- This code IS per eye!!
Low Tension Glaucoma, left eye, moderate stagePrimary Open Angle Glaucoma, right eye , severe stage
7th required ►H40.1222This one already has 6 places so no “X” necessary
Final Codes RequiredH40.11x3 and H40.1222
Diabetes and Diabetic Retinopathy Type II Alphabetic IndexDiabetes, diabetic (mellitus) (sugar) E11.9
-With
. . .-- cataract E11.36
. . .- - retinopathy E11.319
- - - with macular edema E11.311
- - - nonproliferative E11.329
- - - - with macular edema E11.321
- - - - mild E11.329
- - - - - with macular edema E11.321
- - - - moderate E11.339
- - - - - with macular edema E11.331
- - - - severe E11.349
- - - - - with macular edema E11.341
- - - proliferative E11.359
- - - - with macular edema E11.351
NOTE:None of codes are under Retina section
Must look under Chapter 4Codes E8-E13
NOTE: divisions under DM + retinopathy
Diabetes and Diabetic Retinopathy Type II Tabular Listing
Type I and Type II are separate sections“Use Additional Code” Note
Excludes1
Diabetes and Diabetic Retinopathy Type II Tabular Listing
Each type of retinopathy has it’s own codeNon-proliferative - Mild Moderate Severe and Proliferative
With and without Macular Edema
Diabetes and Diabetic Retinopathy Type II Tabular Listing
Code as:E11.339 and Z79.4
Remember “Use Additional Code” Note for Insulin use
Example: IDDM Type II with moderate non-proliferative retinopathy without macular edema
Ocular Injury Coding PrinciplesExternal Cause, Activity, Place of Occurrence
1. External causes of morbidity codes never sequenced as first diagnosis
2. External cause code used for length of treatment with appropriate 7th
character
3. Assign as many external cause codes as necessary
4. Combination external cause codes should correspond to sequence of events without regard for which caused most serious injury
- fall causing a strike against something injury
Ocular Injury Coding PrinciplesExternal Cause, Activity, Place of OccurrenceSecondary Codes
1. Place of occurrence (Y92)Location of the patient at time of injury or other condition
2. Activity code (Y93)
Describe activity at time of injury or other health condition
3. External cause status code (Y99)
Military, Civilian Work, Volunteer, Other Work, Not specified
Place of occurrence, activity, and external cause status codes are sequenced after main external cause code(s)
There is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless a provider is subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, reporting of ICD-10-CM codes in Chapter 20, External Causes of Morbidity, is not required.
In the absence of a mandatory reporting requirement, providers are encouraged to voluntarily report external cause codes, as they provide valuable data for injury research and evaluation of injury prevention strategies.
Ocular Injury Coding PrinciplesExternal Cause, Activity, Place of Occurrence
Chief complaint: “My right eye hurts”
Cutting tree limbs in my yard this morning when I bumped into a branch. Since then, my right eye has been tearing and watering. Sensitive to light and painful.
Finding: Corneal abrasion of central cornea in right eye
Diagnosis: Corneal abrasion OD
But how do we code this injury?
Corneal Abrasion, right eye, central-Tree limbHome Yard Work – No fall involved
Corneal Abrasion, right eye, central-Tree limb
Alphabetic Index
Cornea – see condition
…
Abrasion T14.8
. . .
-cornea S05.0-
Go to S05.0- section in Chapter 19
Corneal Abrasion, right eye, central-Tree limb
NOTE: DIFFERENT 7th character than glaucoma!!
Read Notes at beginning of chapter
Corneal Abrasion, right eye, central-Tree limb
S05.01 is part of code but need 7th character AND external cause
Corneal Abrasion: right eye, central-Tree limb
Diagnosis for initial encounter for injury
Code is S05.01XA
Diagnosis for subsequent encounter for injury
Code is S05.01XD
Diagnosis for sequela to original injury
Code is S05.01XS
Now find EXTERNAL CAUSE for injury
Corneal Abrasion: right eye, central-Tree limb
But First ►Sequela (Late Effects)
Residual effect (condition produced) after acute phase of illness or injury
No time limit on when sequela code can be used
may be apparent early or may occur months or years later
Coding of sequela generally requires two codes sequenced in following order:
1. Condition or nature of sequela first
2. Sequela code is sequenced second
Recurrent corneal erosion following an initial abrasionH18.831 then S05.01xS
Corneal Abrasion: right eye, central-Tree limb
Use secondary code(s) from Chapter 20-(External causes of morbidity) to indicate cause of injury when code of condition requires
When review all index in Chapter 20MAYBE:
Y29 → Y29.XXXA, Y29.XXXD, Y29.XXXS
Corneal Abrasion: right eye, central-Tree limb
Second code depends on whether you choose Bumped by or Striking against
Contact with nonvenomous plant thorns and spines and sharp leaves??
W60.XXXA, W60.XXXD, W60.XXXS
S05.01XA and W22.8XXA or Y29.XXXA
OR is it?
MAYBE…
Corneal Abrasion, right eye, central-Tree limbHome Yard Work – No fall involved
S05.01XA and W22.8XXA and Y92.007(Injury) (External Cause) (Place)
Find Place of Occurrence Code - Y92
Corneal Abrasion, right eye, central-Tree limbHome Yard Work – No fall involved
Activity Code- what were they doing at time of injury/conditionUse with External Cause Code and Place of Occurrence Code
Corneal Abrasion, right eye, central-Tree limbHome Yard Work – No fall involved
The record SHOULD indicate specifics → pruning trees
Activity Code = Y93.H2
S05.01XA + W22.8XXA + Y92.007 + Y93.H2
Corneal Abrasion, right eye, central-Tree limbHome Yard Work – No fall involved
This section is divided into:Civilian Work related
Military relatedVolunteer related
Other related (leisure, student, etc)Not specified related
Again, while example does not indicate external cause, the Record should
Final Code Choices for Initial Encounter
S05.01XA Actual injury – corneal abrasion OD
W22.8XXA External cause- striking against object
(or Y29.XXXA blunt object? or W60.XXXA- nonvenom plant)
Y92.007 Garden/yard private residence
Y93.H2Activity, gardening and landscaping
Y99.8 Other external cause- leisure
Final Code Choices for Subsequent Encounter(s)
S05.01XD
W22.8XXD
Corneal Abrasion, right eye, central-Tree limbHome Yard Work – No fall involved
INITIAL ENCOUNTER ONLY
Take Home Messages
1• Improve documentation to include specific details
2• Ensure your ICD-9-CM coding is very specific
3• Thinking about encounters in terms of ICD-10-CM
4• Practice coding encounters with ICD-10-CM
Take Home Messages
5 • Review of office procedures for ICD-10-CM needs
6• Discussions ICD-10-CM preparation with vendors
• EHR, clearinghouses, insurances
7 • Begin educating yourself
8 • Begin educating staff
9 • Begin saving $$ in case payments are slow
10• Use caution with ICD-9-CM ► ICD-10-CM conversion tables-
• Not always as specific as necessary
ICD-10-CM ResourcesAmerican Optometric Association
www.aoa.org/coding
AOA Coding Today
http://aoa.codingtoday.com/
CDC ICD-10-CM Official USA sitehttp://www.cdc.gov/nchs/icd/icd10cm.htm2016 release of ICD-10-CM at bottom of page has all the downloads
CMS ICD-10-CM information
https://www.cms.gov/Medicare/Coding/ICD10/index.html
X World Health X but Use for general training only
http://apps.who.int/classifications/apps/icd/icd10training
QUESTIONS???
Submit any and all ICD-10-CM questions and any coding questions to:
https://www.aoa.org/ask-the-coding-experts